Inferior petrosal sinus sampling

Case contributed by Dr Lawrence Josey

Presentation

Patient is suffering Cushing disease.

Patient Data

Age: 20
Gender: Male
DSA (angiography)

Check venograms performed prior to inferior petrosal sinus sampling, immediately prior to stimulation (CRF 100ug IV) and after the procedure. On each occasion, satisfactory position shown.

Simultaneous specimens were taken from right and left inferior petrosal sinuses and peripherally. 2 baselines. 3 specimens in the first 5 minutes. 10 minutes. 15 minutes.

Case Discussion

Laboratory report:

Central:peripheral prolactin gradients (>=1.8) indicate successful catheterisation of both IPS.
Central:peripheral ACTH gradients (>=2.0 pre,>=3.0 post-CRH) indicate a pituitary source of ACTH in this case. Left gradients borderline.
Intercavernous ACTH gradients (>=1.4) would be considered by some to be
significant for lateralisation to the Right.

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Case information

rID: 18114
Case created: 10th Jun 2012
Last edited: 18th Dec 2015
Inclusion in quiz mode: Excluded

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